Therapy for pornography addiction

Therapy for Pornography Addiction

Several years ago, I was checking out of one of central London’s many shabby hotels. As I did so, the twenty-something man working on the desk was casually flicking through nude images on his phone. Clearly a guy who might benefit from therapy for pornography addiction. Two things came from this

1) I started to use better hotels

2) I began to think more about treating pornography addiction.

In this blog, and its associated links, I am going to explore what we currently know about compulsive pornography use, its associated effects and therapy for pornography addiction

Therapy for pornography addiction – What is pornography addiction?

There is currently no agreed upon definition of pornography addiction. This is no surprise as some people dispute the use of the word ‘addiction’ (Ley, Prause, & Finn 2014) in this context. However, diagnostic tools have been describes, such as the 8 questions , but no level has yet been set to give a clinical definition. Essentially, it is the client who defines the condition by stating they have it and how it affects them.

Therapy for pornography addiction – is pornography addiction bad?

Whatever your personal opinions about the use of pornography, it seems pretty clear that it is a part of our world and it’s here to stay. There is a long standing debate regarding the pro’s and con’s of pornography which we will not engage in depth with here. Suffice to say that some studies have found that it is associated with a number of positives, (Watson 2012) such as greater sexual adventurousness (Häggström-Nordin, Hanson & Tydén 2005 & Štulhofer, Buško 2010), greater open-mindedness on social issues (Diamond 2009) and the concept that pornography use leads to abusive behaviour is far from proven, with some evidence suggesting the opposite. (Baron 1977 & Kutchinsky 1973, Brannigan, Kapardis 1985) This chimes with my experience of clients for pornography addiction, who I generally find to be not very socially aggressive and often not especially confident.

The consequences which most often affect clients and drive them to therapy in my experience are

1) Erectile dysfunction and associated issues with sexual performance, which come from over masturbation. Often, they find they are avoiding sex or their partner so that they never have to risk being a failure in bed.

2) Relationship issues. These most commonly arise when the partner is offended or insulted by the pornography use, seeing it as either a criticism (“am I not enough for you!”) or they feel in competition with the porn-stars. Relationship issues can also occur when the constant exposure to adventurous sexual behaviour or highly attractive people stimulates a dissatisfaction in the user with their current life.

3) Religious and spiritual issues. The deeply spiritual are not immune to the temptations of pornography, indeed the thrill of ‘breaking the rules’ may even be part of the attraction. Such people tend to present for therapy when they fear the rejection or chastisement of their community, or when their own spiritual or moral compass will no longer tolerate the lack of integrity.

4) Time issues. A lot of people use pornography for long periods, jumping from scene to scene without ever reaching climax. The result of which is that hours of otherwise useful time are lost to them.

5) Relationship substitution. This is where the client is aware that they are using pornography instead of pursuing a relationship. Often they will be aware that a real relationship will be more fulfilling but have little drive to get a partner, their sexual desires being sated.

Therapy for pornography addiction – Treatment

My personal preferred approach is the Acceptance and Commitment Therapy (ACT) model. Although, it is unwise to be wedded to any one therapy approach, I use the ACT model as a starting point. ACT had one of the best evidence basis for treating pornography addiction at the time I wanted to learn how to treat it, (Twohig, Crosby & Cox 2009, Twohig, & Crosby 2010) but others have proven effective. The basic’ of this treatment involve

Focusing the client on the things of emotional value to them over the long term.

Helping the client to change their relationship with pornographic thoughts and feeling. This may be done through mindfulness exercises, desensitisation work or metaphors.

Lifestyle changes which seek to reduce the problem behaviours or focus energy into ‘healthy’ environments.

There is far more to this kind of work than this, rapport is essential. The therapist needs to be comfortable conversing in crude terms and acknowledging the human desires which drive pornography use as valid. As with all therapy the creation of a non-judgemental environment is essential. The techniques themselves may be quite straightforward but it is only in rapport that you will be able to effectively deploy them.